Additional Personnel Research Articles

Supporting young children’s social emotional competence in the Republic of Georgia: a focus group study

ABSTRACT This study utilized six focus groups to explore 49 early childhood teachers’ perspectives and reported use of Pyramid Model practices to support young children’s social emotional competence in the Republic of Georgia. Constant comparison analysis was used to analyze participants’ responses. Early childhood educators described implementing some social emotional interventions and supports across tiers of the Pyramid Model in Georgian early childhood classrooms. Early childhood teachers across regions expressed the need for additional personnel, training, and social emotional resources. Implications of the findings are discussed in terms of the importance of ensuring the cultural fit of frameworks such as the Pyramid Model.

V03-09 MANAGEMENT OF INTRAOPERATIVE VASCULAR INJURIES IN UROLOGIC SINGLE-PORT OR MULTI-PORT ROBOTIC SURGERY

You have accessJournal of UrologyCME1 Apr 2023V03-09 MANAGEMENT OF INTRAOPERATIVE VASCULAR INJURIES IN UROLOGIC SINGLE-PORT OR MULTI-PORT ROBOTIC SURGERY Anh Nguyen, David Ali, Benjamin Rudnick, Rogerio Huang, Mubashir Shabil Billah, and Mutahar Ahmed Anh NguyenAnh Nguyen More articles by this author , David AliDavid Ali More articles by this author , Benjamin RudnickBenjamin Rudnick More articles by this author , Rogerio HuangRogerio Huang More articles by this author , Mubashir Shabil BillahMubashir Shabil Billah More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are many challenges to managing vascular injuries during robotic urologic surgeries. These include limited exposure due to the small field, inability to quickly expand the surgical field with retractors and additional personnel, inability manually palpate or apply manual pressure over a broad area, and reliance on a limited array of robotic instruments. Other challenges include the limited field of vision of the robotic camera, as well as reliance on insufflation to maintain adequate visualization. Consultant surgeons may not have significant experience with using the robot. These all can translate into longer operative times for repair of vascular injuries with resultant blood loss. We sought to share insights on how a robotic surgeon may handle repairing a vascular injury. METHODS: Three robotic multi- and single-port operative cases with vascular injuries were examined. Operative strategy was analyzed and discussed. RESULTS: A single-port robotic nephroureterctomy was done on a 68 year-old female with past history of endometrial cancer, hysterectomy with lymph node dissection, and radiation to the pelvis. A common iliac vein injury was incurred during dissection of the distal ureter and was repaired using robotic 4th arm to clamp the injured vessel, strategic use of ROSI suction, and non-absorbable 4-0 suture. A multi-port robotic radical prostatectomy was done on a 63 year-old male with history of Gleason 4+3 prostate cancer with inadvertent injury of the external iliac artery. A combination of robotic bulldog clamps, assistant suction and non-absorbable 4-0 suture was used to successfully repair the injury. Lastly, a multi-port robotic adrenalectomy was done for a 48 year-old female with a 6.5 cm adrenal mass with invasion into the IVC. Repair of the IVC was done with a combination of 4th arm and bulldog clamps, vessel loop traction, and non-absorbable 4-0 suture. CONCLUSIONS: Strategies to robotically repair inadvertent vascular injuries during urologic surgery require strategic use of the 4th robotic arm, assistant- or robotically-applied clamps, and assistant instruments to free up working arms. Non-absorbable suture should be readily available. Closure of large blood vessels require releasing clamps momentarily before closure to avoid air embolus. Maximal visualization can be achieved using the zoom features of the robotic camera and its ability to discriminate fine detail. Maintaining composure with frequent and adequate communication with anesthesia and intensive care teams is vital in safely managing vascular injuries. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e248 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anh Nguyen More articles by this author David Ali More articles by this author Benjamin Rudnick More articles by this author Rogerio Huang More articles by this author Mubashir Shabil Billah More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...

Determination of workers' compliance to safety regulations using a spatio-temporal graph convolution network

The safety of workers in construction remains a critical issue despite the automation of several tasks with fewer workers on site. As fatal accidents of workers account for a significant number of construction accidents, considerable effort has been made to monitor workers’ safety behaviors with additional personnel for supervising workers. With the advancement of data analytics, recent research has reported various human activity recognition methods based on image data to perform automated worker monitoring without additional labor. Nevertheless, unlike existing approaches based on a single image, a method that can capture a series of actions from sequential images is required to monitor workers’ compliance with safety behavior. To this end, an approach based on OpenPose and a spatio-temporal graph convolutional network is proposed in this study to evaluate workers’ compliance with safety regulations using sequential videos. The two primary functions of the developed method include 1) classifying each safety behavior among five representative behaviors stipulated in construction, and 2) determining the compliance of workers with each safety regulation. The results indicate that the developed approach can capture momentary safety behaviors and workers’ compliance with feasible accuracy of an average F1 score greater than 0.8. Furthermore, the proposed method can be extended to safety intervention policies with behavior-based feedback to inform workers of their non-compliance with safety behaviors. Therefore, this study contributes to proactive safety management by focusing on workers’ behavioral levels rather than on accident rate-based management.

Handlungsempfehlungen für SARS-CoV-2-Testkonzepte für asymptomatische Beschäftigte im Gesundheitswesen

ZusammenfassungHintergrund und ZielsetzungBei der Umsetzung von SARS-CoV‑2-Testkonzepten in Einrichtungen des Gesundheitswesens kommen ranggleiche Gesetze und Verordnungen zur Anwendung. Vor dem Hintergrund erlebter Hindernisse bei einer adäquaten Umsetzung gesetzlicher Vorgaben in regelkonforme und rechtssichere Prozesse auf betrieblicher Ebene war das Ziel der vorliegenden Arbeit, dafür konkrete Handlungsempfehlungen zu entwickeln.MethodikIn einer Fokusgruppe mit Vertreter*innen aus Behörden, Fachschaften und Interessenvertretungen wurden auf Basis von Leitfragen aus zuvor identifizierten Handlungsfeldern in einem holistischen Ansatz kritische Aspekte der Umsetzung diskutiert. Die transkribierten Inhalte wurden anhand deduktiv-induktiver Kategorienbildung qualitativ analysiert.ErgebnisseAlle Diskussionsinhalte konnten den identifizierten Kategorien Gesetzliche Hintergründe von, Anforderungen an und Zielrichtungen für Testkonzepte in Gesundheitseinrichtungen, Zuständigkeiten für Umsetzung in betrieblichen Entscheidungsketten sowie Implementierung von SARS-CoV-2-Testkonzepten/Testprozessen zugeordnet werden.ImplikationenDie Umsetzung gesetzlicher Vorgaben in regelkonforme und rechtssichere SARS-CoV-2-Testkonzepte in Einrichtungen des Gesundheitswesens setzt bereits sowohl die Einbeziehung von Ministerien, Fachschaftsvertretungen, Berufsverbänden, Arbeitgeber(AG)- und Arbeitnehmer*innenvertretungen, Datenschutzexpert*innen, Vertretungen möglicher Kostenträger als auch eine integrative und vollzugstaugliche Formulierung von Gesetzen und Verordnungen voraus. Die Definition von Zielrichtungen für Testkonzepte ist maßgeblich für nachfolgend im Betrieb etablierte Prozessabläufe, bei denen Aspekte des Beschäftigtendatenschutzes genauso berücksichtigt werden müssen wie die Bereitstellung zusätzlicher personeller Ressourcen für die Bewältigung der Aufgaben. Zudem muss es in Zukunft ein zentrales Anliegen der Betriebe sein, IT-Schnittstellenlösungen für eine datenschutzkonforme Informationsweitergabe zu Beschäftigten zu finden.

Early Childhood Administrator Perspectives About Preschool Inclusion: A Qualitative Interview Study.

The online version contains supplementary material available at 10.1007/s10643-023-01448-0.

Automated Emails to Improve Evening Staffing for Anesthesiologists.

Scheduling flexibility and predictability to the end of a clinical workday are strategies aimed at addressing physician burnout. A voluntary relief shift was created to increase the pool of anesthesiologists providing end of the day relief. We hypothesized that an automated email reminder would improve the number of evening relief shifts filled and increase the number of anesthesiologists participating in the program. An automated email reminder was implemented, which selectively emailed anesthesiologists without a clinical assignment one day in advance when the voluntary relief shifts were not filled, and anticipated case volume past 4:00 PM was expected to exceed the capacity of the on-call team. After implementation of the automated email reminder, the median number of providers who worked the relief shift on a typical day was 2.6, compared to 1.75 prior to the intervention. After the initial increase in the number of volunteers post-intervention, the trend in the weekly average number of volunteers tended to decrease but remained higher than before the intervention. A total of 22 unique anesthesiologists chose to participate in this program after the intervention. An automated email reminder increased the number of anesthesiologists volunteering for a relief shift. Leveraging automation to match staffing needs with case volume allows for recruitment of additional personnel on the days when volunteers are most needed. Increasing the pool of anesthesiologists available to provide relief is one strategy to improve end of the day predictability and work-life balance.

The Diagnostic Odyssey of Patients with Chronic Neuropathic Pain-Expert Opinion of Greek Pain Specialists.

The diagnosis of chronic neuropathic pain requires a laborious process and can be a very long journey for the patients, one that can be characterized as an "odyssey." Our aim was to describe the "diagnostic odyssey" associated with chronic neuropathic pain in the Greek context. Specialized clinicians working at dedicated chronic pain and palliative care centers were asked to participate in a survey regarding the diagnostic process in Greece. In total, 44 respondents provided information on the organization of their centers, the diagnostic process, and the perceived obstacles involved in the diagnosis of chronic neuropathic pain. Most respondents reported that their centers were not fully or efficiently organized and believed that additional specialized healthcare personnel should be employed. Raising public awareness about the existence of such centers was also considered key. The two main obstacles in reaching a diagnosis were the difficulty non-experts had in recognizing chronic neuropathic pain and the lack of acknowledgement that chronic neuropathic pain is a condition that needs to be addressed. When considering these responses in light of the extended socioeconomic burden associated with chronic neuropathic pain, efforts should be made to limit the "diagnostic odyssey" of chronic neuropathic pain in Greece. The aim of this study is to explore the experience of patients with chronic neuropathic pain in Greece from the viewpoint of pain specialists. A better organization of pain and palliative care centers, facilitation of communication with previously treating clinicians, increased personnel, utilization of a chronic pain registry, and guidelines development can aid in this venture. Keypoints: The diagnosis of chronic neuropathic pain in Greece is a laborious and time-consuming process that needs to be refined; Greek clinicians believe that their centers were not fully or efficiently organized and think that additional specialized healthcare personnel should be employed; Patient comorbidities and retards in visiting a clinic at the onset of symptoms delay the diagnosis of neuropathic pain and may complicate subsequent care; The diagnostic delay has been reported as three years between the onset of symptoms and seeking general medical help and another nine years before a referral to a pain specialist; Neuropathic pain is associated with patient distress and socioeconomic burdens, and diagnostic delays prolong the condition, may allow it to worsen, and utilize valuable healthcare resources without providing effective solutions.

The impact of energy shortages on health and healthcare in Europe.

The impact of energy shortages on health and healthcare in Europe.

Costs of two vancomycin-resistant enterococci outbreaks in an academic hospital.

In early 2017, the University Medical Center Groningen, the Netherlands, had an outbreak of 2 strains of vancomycin-resistant enterococci (VRE) that spread to various wards. In the summer of 2018, the hospital was again hit by a VRE outbreak, which was detected and controlled early. However, during both outbreaks, fewer patients were admitted to the hospital and various costs were incurred. We quantified the costs of the 2017 and 2018 VRE outbreaks. Using data from various sources in the hospital and interviews, we identified and quantified the costs of the 2 outbreaks, resulting from tests, closed beds (opportunity costs), cleaning, additional personnel, and patient isolation. The University Medical Center Groningen, an academic hospital in the Netherlands. The total costs associated with the 2017 outbreak were estimated to be €335,278 (US $356,826); the total costs associated with the 2018 outbreak were estimated at €149,025 (US $158,602). The main drivers of the costs were the opportunity costs due to the reduction in admitted patients, testing costs, and cleaning costs. Although the second outbreak was considerably shorter, the costs per day were similar to those of the first outbreak. Major investments are associated with the VRE control measures, and an outbreak of VRE can lead to considerable costs for a hospital. Aggressively screening and isolating patients who may be involved in an outbreak of VRE may reduce the overall costs and improve the continuity of care within the hospital.

The roles of emergency medical teams in response to Samoa's 2019 measles outbreak.

On 15 November 2019, Samoa's Government declared a state of emergency in response to a rapidly worsening measles outbreak. The outbreak overwhelmed Samoa's health system, necessitating international assistance, including from emergency medical teams (EMTs). Measles spread globally throughout 2019, with cases rising by more than 300% in the first quarter of 2019, as compared with 2018. Given Samoa's low immunization coverage with a measles-containing vaccine at the time, at 40% for the first dose and 28% for the second, the country was soon overwhelmed with measles cases, hospitalizations and deaths. Following a request for international assistance, 18 EMTs from around the world deployed to Samoa, bringing more than 550 additional clinical, public health and logistics personnel to the country's measles response. Working alongside Samoan health workers, EMTs provided critical surge assistance in clinical management, vaccination, surveillance, infection prevention and control, risk communication and community engagement, and mental health and psychosocial support. A total of 1867 hospitalized measles patients were treated from 30 September 2019 to 13 January 2020, with 83 measles-related deaths recorded. EMTs provided essential surge support across Samoa's health system during the most acute phase of the response, helping to care for the ill and control the outbreak. Samoa's measles response triggered a large-scale and unique EMT activation, with teams integrated into Samoa's hospitals and health centres. The response demonstrated the critical role that EMTs can play in outbreak response and the importance of strong coordination to ensure optimal use of international clinical surge support by a health system in crisis.

Exoskeletal solutions to enable mobility with a lower leg fracture in austere environments.

The treatment and evacuation of people with lower limb fractures in austere environments presents unique challenges that assistive exoskeletal devices could address. In these dangerous situations, independent mobility for the injured can preserve their vital capabilities so that they can safely evacuate and minimize the need for additional personnel to help. This expert view article discusses how different exoskeleton archetypes could provide independent mobility while satisfying the requisite needs for portability, maintainability, durability, and adaptability to be available and useful within austere environments. The authors also discuss areas of development that would enable exoskeletons to operate more effectively in these scenarios as well as preserve the health of the injured limb so that definitive treatment after evacuation will produce better outcomes.

UPAYA KOMISI PEMILIHAN UMUM (KPU) KOTA SURABAYA DALAM MENGELOLA DATA PEMILIH UNTUK MENINGKATKAN EFEKTIVITAS KINERJA PEMILU

The General Election (Pemilu) is a democratic party conducted by a country. One of the countries that uses democracy is the State of Indonesia where the highest system of sovereignty and power lies in the hands of the people. Voter data in the Permanent Voter List (DPT) will continue to occur in the implementation of general elections which are held every 5 years, thus creating problems that occur in the collection and management of voter data. This study aims to determine the extent of efforts in managing voter data at the Surabaya City Election Commission to support the successful implementation of tasks. Then knowing what factors are supporting and hindering in managing voter data at the Surabaya City Election Commission so as to find out the extent of the influence of factors on task success. To find out the extent of the success of the tasks carried out by the Surabaya City KPU in Improving the Effectiveness of Election Performance. This study uses qualitative research methods. Qualitative research in data collection techniques uses in-depth interviews, documentation and literature to obtain relevant data and collect voter data information to understand how the General Election Commission (KPU) institution can improve the effectiveness of election performance. Sources of information in this study are those who have all thoughts about official activities to improve voter data management and improve the effectiveness of election performance, the subject of this research is ASN and Additional Personnel of the General Election Commission (KPU) of Surabaya City. The results show that activities in managing data voters at the Surabaya City KPU in order to support the general election have several stages of Standard Operating Procedure or SOP in the data input process. As for inputting or managing voter data, it also has inhibiting and supporting factors that affect the program. as well as the process of updating voter data such as New Additional Voter Data (DPTb), Transfer Voter Data (DPPh), Permanent Voter Data (DPT) in order to produce good voter data as reference material in the next general election in order to improve the effectiveness of election performance. Voter data is used as a reference for continuous general elections in order to improve the effectiveness of election performance.

Development and Validation of a Prediction Model for Need for Massive Transfusion During Surgery Using Intraoperative Hemodynamic Monitoring Data

Massive transfusion is essential to prevent complications during uncontrolled intraoperative hemorrhage. As massive transfusion requires time for blood product preparation and additional medical personnel for a team-based approach, early prediction of massive transfusion is crucial for appropriate management. To evaluate a real-time prediction model for massive transfusion during surgery based on the incorporation of preoperative data and intraoperative hemodynamic monitoring data. This prognostic study used data sets from patients who underwent surgery with invasive blood pressure monitoring at Seoul National University Hospital (SNUH) from 2016 to 2019 and Boramae Medical Center (BMC) from 2020 to 2021. SNUH represented the development and internal validation data sets (n = 17 986 patients), and BMC represented the external validation data sets (n = 494 patients). Data were analyzed from November 2020 to December 2021. A deep learning-based real-time prediction model for massive transfusion. Massive transfusion was defined as a transfusion of 3 or more units of red blood cells over an hour. A preoperative prediction model for massive transfusion was developed using preoperative variables. Subsequently, a real-time prediction model using preoperative and intraoperative parameters was constructed to predict massive transfusion 10 minutes in advance. A prediction model, the massive transfusion index, calculated the risk of massive transfusion in real time. Among 17 986 patients at SNUH (mean [SD] age, 58.65 [14.81] years; 9036 [50.2%] female), 416 patients (2.3%) underwent massive transfusion during the operation (mean [SD] duration of operation, 170.99 [105.03] minutes). The real-time prediction model constructed with the use of preoperative and intraoperative parameters significantly outperformed the preoperative prediction model (area under the receiver characteristic curve [AUROC], 0.972; 95% CI, 0.968-0.976 vs AUROC, 0.824; 95% CI, 0.813-0.834 in the SNUH internal validation data set; P < .001). Patients with the highest massive transfusion index (ie, >90th percentile) had a 47.5-fold increased risk for a massive transfusion compared with those with a lower massive transfusion index (ie, <80th percentile). The real-time prediction model also showed excellent performance in the external validation data set (AUROC of 0.943 [95% CI, 0.919-0.961] in BMC). The findings of this prognostic study suggest that the real-time prediction model for massive transfusion showed high accuracy of prediction performance, enabling early intervention for high-risk patients. It suggests strong confidence in artificial intelligence-assisted clinical decision support systems in the operating field.

Mathematical Modeling of COVID-19 Transmission in the Form of System of Integro-Differential Equations

The model of the spread of the coronavirus pandemic in the form of a system of integro-differential equations is studied. We focus our consideration on the number of hospitalized patients, i.e., on the needs of the system regarding hospital beds that can be provided for hospitalization and the corresponding medical personnel. Traditionally, in such models, the number of places needed was defined as a certain percentage of the number of infected at the moment. This is not quite adequate, since it takes a certain period of time for the development of the disease to the stage at which hospitalization is required. This will be especially evident at the start of new waves of the epidemic, when there is a large surge in the number of infected people, but the need for hospitalization places and additional medical personnel will appear later. Taking this circumstance into account using integral terms in the model allows us to conclude in corresponding additional to existing cases that the wave of disease will attenuate after some time. In others, it will relieve unnecessary panic, because the healthcare system has a certain period to create additional hospitalization places, order medicines and mobilize the necessary medical personnel. We obtain estimates of reproduction number in the case of the model described by a system of integro-differential equations. Results on the exponential stability of this integro-differential system are obtained. It is demonstrated that the condition of the exponential stability coincides with the fact that the reproduction number of the spread of the pandemic is less than one.

An MDT approach to reduce the need for general anaesthetic in young children to perform MSK MRI

Background: Magnetic resonance imaging (MRI) is commonly used to diagnose musculoskeletal (MSK) disease in children including appendicular, spine and whole-body imaging. For diagnostic-quality images patients need to be immobile for a prolonged period; for example, imaging an extremity takes approximately 35 minutes and whole-body MRI one hour. This frequently means general anaesthetic (GA) is used for MRI examinations in young children and is often seen as the default option. However, this has disadvantages including the risks of a GA, longer waiting times being one of the highest in trusts, higher additional costs (£164 additional cost per patient) and additional specialist personnel.

Health-related effects of an intervention involving reduced working hours among women employed in the municipal eldercare

Working conditions of eldercare are often characterized by a high workload and different organizational approaches have been suggested to reduce the potentially negative health-related effects of such conditions. One of the suggested approaches involves reducing the exposure to such working conditions by reducing the number of working hours. However, the knowledge of the concurrent health-related effects of working fewer hours remains limited. This longitudinal study set out to examine the health-related effects of an intervention involving daily working hours being reduced from ≥7 to 6 h. Data came from an organizational intervention that included 68 women employed in the municipal eldercare. All employees retained full-time salaries and additional personnel were employed by the organization in order to provide full services throughout the intervention period. A broad range of biomarkers and self-ratings in questionnaires were obtained before the intervention, 6 months after the change, and 12 months after the initial change. Measurements among referents (n = 19), matched with respect to type of work, were performed at corresponding time points. Results from repeated measures ANOVAs showed significant interaction effects for diastolic blood pressure and HbA1c with these effects being primarily related to changes among referents. No other significant group differences were found. Time-related effects emerged in both groups but cannot be attributed to the intervention as such. To conclude, this study showed none of the hypothesized health promoting or other consistent effects of reduced working hours.

COVID-19 RISK IN THE CARDIAC CATHETERIZATION LABORATORY

COVID-19 RISK IN THE CARDIAC CATHETERIZATION LABORATORY

A Simplified Approach to Jaw-in-a-Day Using a Preassembled Prosthesis: Lowering the Barrier to Entry.

Summary:Fibula flap reconstruction with primary dental implant placement has been established as a successful procedure for composite mandibular defects. When using virtual surgical planning, these techniques typically require additional personnel and materials preoperatively and intraoperatively to fabricate occlusal-based guidance and prosthesis. The authors present a technique utilizing a custom-made implant-supported prosthesis completed before surgery that greatly reduces lead time and needed resources. The authors follow the established workflow of segmental mandibulectomy and fibula flap reconstruction using premanufactured cutting guides and placement of dental implants. Cylindrical holes along the implant axes are included in the printed surgical model provided by the guide manufacturer. Acrylic resin and abutments are added to the model to a positioning stent for use during surgery that does not require intraoperative modification before fibula inset. This ensures optimal position for facial esthetics and fixed dental rehabilitation. The presented technique uses printed models already provided by the guide manufacturer, reducing preparation time and requiring fewer personnel and materials intraoperatively. This is an approach to the jaw-in-a-day procedure with a lower barrier to entry that may be used by new craniofacial teams.

An analysis of the costs to provide high-quality and individualized emergent literacy support in pre-K classrooms

Emergent literacy skills are a critical base for later academic success. Since gaps in reading skills appear as early as kindergarten, pre-K programs are compelled to increase the quality of whole class literacy instruction and to provide additional personalized support as needed. Given that additional personnel are needed to do both, there is a policy tension: hiring certified specialists that follow an evidence-based approach or utilizing a more affordable option that uses unpaid volunteer instructors where quality may be mixed. In this study, we explore an alternative emergent literacy model called the Minnesota Reading Corps (MRC) Pre-K Program and analyze its associated costs. The MRC Pre-K model places stipend AmeriCorps members into existing pre-K classrooms and integrates coaching and supervisory support from certified instructors, making enhanced whole-class literacy instruction and at-risk support possible. Using the ingredients method (Levin et al., 2018), we estimate that the average incremental cost per student of the MRC Pre-K Program is approximately $1,300 per year. We find that the majority of costs are borne by the MRC program (38%), with a much smaller portion of the costs borne by schools (25%), primarily from a reallocation of school staff time. These results demonstrate the opportunity of MRC with trained AmeriCorps members to increase early literacy support at a low-cost to schools.

233. A ’low-resource' pilot to increase PRO response rates in an urban spine clinic

233. A ’low-resource' pilot to increase PRO response rates in an urban spine clinic